Health Center Staff Take Lead Role In Preparing Their Campuses For Pandemic Flu

It sounds like the plot of the next blockbusterstudents who are likely to be dependent on care.
movie. A third of the world's population is struck* The size of your staff (taking into account that
down by a deadly virus that spreads across theup to 50 percent may be sick at one time). *
globe so rapidly that there is no time to develop aYour ability to stockpile enough basic supplies,
vaccine. Up to half of those infected - evenincluding medications, as well as personal
young, healthy adults - die. But as healthprotective equipment such as respirators. This is
professionals know, this scenario is not just awhere things start to get more complicated,
flight of fancy. It could be the very real effectshowever. Most student health services can't
of the next pandemic flu outbreak, particularly ifafford to stockpile many medical supplies. "ACHA
H5N1 (also known as highly pathogenic avian flu) isis running a survey on pandemic planning," reveals
the virus in question, and it is this knowledge thatBarkin. "Of the schools that have responded,
is pushing not just federal and state governmentmost have not stockpiled, or if they have, it's not
but organizations and businesses throughout thea lot." This could clearly prove disastrous, and for
world to develop a strategy to tackle it. Withinmany colleges is a manifestation of what Covely
colleges and universities, the burden of pandemiccites as one of the biggest challenges of pandemic
flu planning is likely to fall upon many studentplanning for some universities: "getting buy-in from
health directors, even at institutions withthe executive leadership." Pandemic planning is by
environmental health and safety departments.no means a cost-free exercise. One tip if you are
John Covely, a consultant on pandemic flu planningfacing resistance from campus decision-makers
and the co-author of the University of Northover spending money on pandemic planning is to
Carolina at Chapel Hill's pandemic plan, explainsemphasize the fact that once you've formulated
why this is so. "Traditionally, emergency planninga response to a possible pandemic, you will have
originates from public safety, or environmenta robust emergency response strategy that can
health and safety, but a communicable diseasebe adapted to fit virtually any emergency,
poses the biggest threat to students in groupwhether it's evacuation in the event of wildfires,
quarters. Thus, student health directors are oftensuch as Pepperdine University faced recently, a
leading the emergency planning effort for theterrorist threat, or an "active shooter".
whole university, because the entire plan - notInvestment in, say, developing a Web site with
just the student health component - could be theemergency information and updates can be a
difference in life or death for their students." Thepublic relations bonus and a reliable resource.
importance of having a campus-wide plan that isVillanova University's plan includes broadcasting
ready - not just in the preliminary stages - whenSMS text messages and e-mails and using an
the pandemic strikes is all the more clear whenemergency Web page for mass communication.
you consider that, unlike seasonal flu, H5N1 has anDr. Mary McGonigle, director of the student health
increased risk for the typical student demographiccenter at Villanova University, says that their
of young, healthy adults. The startlingly highdialogue with their local health department led to
mortality rate of up to 60 percent is partly dueVillanova being assessed and labeled a "push" site,
to a protein, also found in the strain of virusa location that is self-sufficient in this type of
responsible for the 1918 pandemic flu outbreak,emergency. She explains: "In the event of a
which causes a response in a healthy immunepandemic, we'd go and pick up supplies from the
system known as a "cytokine storm", oftencounty and then administer medicine to our
leading to respiratory failure and death. PlanningVillanova community. That includes students,
for such a massive and yet unpredictable eventfaculty and their families." Help from the county is
may seem a formidable task, but Dr. Anita Barkin,a financial boon but being self-sufficient and
chair of the American College Health Association'sstaying local also lowers the risk of spreading the
pandemic planning committee, counsels that thosevirus so rapidly. The dialogue helps your local
universities and colleges that have yet tohealth services too. If your local hospitals are likely
formulate a pandemic plan shouldn't feelto have a shortage of beds, they may want to
overwhelmed by the work that lies before them.use college dorms for surge capacity at the peak
"Pandemic planning is about good emergencyof a pandemic. In return, they may be able to
preparedness. The things we do to prepare foroffer you some resources, although research
any emergency are the things we would do tosuggests that most hospitals have not had the
prepare for pandemic flu," she explains. Althoughbudget to be able to stockpile effectively either.
the tragic Virginia Tech shootings this spring wereThe ongoing and fluid nature of pandemic planning
a different kind of emergency, the issues areis very much evident in some of the complex and
similar to the issues faced in the event of athorny issues that have no definitive answer.
pandemic flu outbreak. Coordinating resources,These may need to be revisited and rethought as
communicating with everyone on campus andscientific discoveries are made, as you approach a
deciding at what stage classes should be called offpandemic, and if your college's resources change.
are questions that have to be answered in mostOne such issue is the availability of expensive
emergency situations. Take your pandemicantivirals. The federal government has announced
planning one step at a time, advises Barkin. "Thethat it is stockpiling them and coming up with a
first step is to find out whether there is anstrategy for distribution, which might seem to
existing emergency plan on campus," she says. "Iftake some of the financial pressure off student
there is, who is in charge of it? Health providershealth services. Barkin however has a caveat. "I'm
on campus should then take charge and begin toconcerned that stockpiles would not be distributed
formulate the plan." There are many unknownin enough of a timely fashion to make an impact
factors, but build the framework of the plan firston the community. Katrina is a situation that has
with the elements you can be sure of. Form ato come to mind." Even if you did manage to
committee with all key areas represented,persuade campus decision-makers to invest
including executive leadership. ACHA's Guidelinesbudget in stockpiling antivirals, a potentially
for Pandemic Planning provides a list as anchallenging feat, there's a chance that they would
example that may help you collate this. Identifybe ineffective by the time a pandemic occurs, as
the functions that will be critical in the case of aoveruse can cause the emergence of a resistant
pandemic and the personnel on campusstrain. Barkin explains that infectious disease
responsible for each of these, making sure thereexperts are talking about using a treatment
are enough people representing each function thatcocktail - Tamiflu plus one or two other agents -
should some become sick, the plan is notto protect against the emergence of resistant
compromised. Identify decision makers, a chain ofstrains, but this would be prohibitively expensive
command, and what channels of communicationfor the average college health center. Another
are to be used. Finally, decide on the role ofethical dilemma surrounding pandemic planning
student health services. Many campuses will haveconcerns who should get prepandemic vaccines.
the student health director as the key decisionScientists are developing vaccines based on the
maker in the event of a pandemic, but for somestrain of avian flu that has been circulating in Asia,
it will be more appropriate for the student healthhoping that the vaccine would be enough of a
director to have an advisory role instead. In anymatch to combat the illness until a proper vaccine
case, college health professionals will be crucial tocould be developed six months after the
the success of every plan. The biggest questionpandemic's emergence. But supplies of this
that is central to every campus-wide pandemicprepandemic vaccine will be limited. "Some of the
plan: when is the right time to send studentsconversations around who should get these
home? Covely warns that universities cannotprepandemic vaccines are very complex," says
necessarily wait for cues from state public healthBarkin. "Should it be health care workers that get
departments before they make their decisions.it, or public safety workers such as firemen?
"The university has to have its own in-depthShould it be government officials, or the very
criteria in advance of a pandemic, and the studentyoung and elderly?" Recently, the federal
health director should be very involved ingovernment has announced a three-tiered
developing those criteria." Don't wait too long toapproach to vaccination that it has developed in
send your students home. Nor should your triggerconsultation with public focus groups and ethicists
for this decision rely on the geographical proximitythat places health care workers in the second tier.
of the virus to your campus alone. The factorsWhether your health center staff will receive the
that will determine how early you make the call tovaccine, whether it will be in a timely fashion, and
send students home will center on thehow effective it will actually be, are all factors
composition of your student population. If yourthat will affect your pandemic plan greatly - and
students are mostly from in-state, they willdemonstrate how much of your planning has to
probably be traveling home by car and so youleave room for the unknown. One thing that is
can wait slightly longer before canceling classesbeyond question is the importance of student
and closing the campus down. If many studentshealth services acting now. Formulating a
live a long way away and are going to need topandemic plan may be a slow and ponderous
use mass transportation, you may have to acttask, but there's one vital aspect that will slow the
more quickly or risk being swamped with very illspread of a pandemic and can be tackled by your
students at a time when the local hospitals will notdepartment immediately without getting tangled in
have the resources to help. There are three mainred tape and endless meetings. This public health
elements that will shape the logistics and the scaleeducation can be a collaborative effort with
of your plan, and help you figure out the besthuman resources and residence life staff. Covely
trigger to send students home. Remember that,agrees and even suggests extending the scope
as Barkin comments, "The longer you wait, thebeyond campus boundaries. "It's part of being a
higher the rate of infection, the less chance ofgood and responsible neighbor to the community,"
being able to get students home and the lesshe says.
likely you can manage the burden of disease."Cassie Harman is a writer for Nuesoft
These factors are as follows: * StudentTechnologies, a provider of medical practice
demographics, particularly the number of studentsmanagement software.
who live on campus and the number of non-local